Patients with malignant mesothelioma have several treatment options, but they aren't considered curative.

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Malignant mesothelioma, or just mesothelioma, is a very sneaky cancer. Usually deadly, this cancer has few symptoms — shortness of breath, maybe a dry cough — in its early stages. By the time a patient sees a doctor about his symptoms, the disease is often well advanced.

Bartolome R. Celli, MD, chief of pulmonary care at St. Elizabeth’s Medical Center in Boston, says that while some more “aggressive” medical hubs in the United States operate on mesothelioma patients, most patients are diagnosed too late for anything but palliative care designed to make them more comfortable. “Most patients will get supportive and comfort measures because the disease is too advanced,” says Dr. Celli.

That doesn’t mean that all patients face an immediately grim future. If the patient is young and the mesothelioma has not yet spread into the lymph nodes, then there is a good chance that the patient will still be alive in five years, says Neil Schachter, MD, medical director of respiratory care and professor of pulmonary medicine at the Mount Sinai Medical Center in New York City.

Malignant Mesothelioma: Treatment Options

Treatments for most cancers depend on many factors, like how far the cancer has spread, where the cancer is located, how old the patient is, and what he wants. Treatment for mesothelioma is no different.

The standard mesothelioma treatment options range from surgery to radiation therapy and chemotherapy — or a combination of all three — depending on a patient’s age and health condition.

The treatment plan that increases life expectancy is surgery first, along with chemotherapy and radiation, says Dr. Schachter. But again, this depends on the person’s situation.

Standard treatments for malignant mesothelioma include:

Surgery. This is performed to remove part of the chest or abdomen lining, a lung, and even some of the diaphragm.

Targeted radiation. “Mesothelioma is radiation-sensitive, so radiotherapy is also used for this,” says Schachter. “In some cases, you can shrink the tumor, improve quality of life, and possibly prolong survival with radiation. And radiation is often used in combination with surgery because with the lung removed, it’s easier to radiate the chest.”

Intravenous chemotherapy. The two drugs most commonly used for mesothelioma are cisplatin (Platinol) and pemetrexed (Alimta), Schachter says. “Given together, they seem to give the best results.”

Malignant Mesothelioma: Surgery

The main type of surgery for mesothelioma is called extrapleural pneumonectomy. This involves taking out the lung on the side that has the mesothelioma, along with some surrounding tissues, Schachter says.

“That’s major surgery,” he continues. Sometimes, part of the diaphragm on that side is also taken, but that happens primarily if the patient is under age 55 when he is diagnosed, or if there is no evidence that the cancer has spread into local lymph nodes. “Then, your chances of responding to surgery are better.”

And if surgery is out of the question? “Chemotherapy is the next best bet for primary therapy,” says Schachter.

Malignant Mesothelioma: Choosing Treatment Options

Choosing treatment is very individualized and should be done in consultation with a patient’s primary physician and oncologist.

But Schachter says the choice is often up to surgeons. “Obviously, patients have to make up their minds whether they want to go through this. But not everybody is a good candidate for these kinds of treatments.”

Patients may want to consider contacting experienced, large cancer centers for their malignant mesothelioma treatment. These places often offer patients better survival rates than hospitals that do not see many patients with the condition.

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